Assessment of the learning curve for EUS-guided gastroenterostomy for a single operator

Jovani, Manol; Ichkhanian, Yervant; Parsa, Nasim; Singh, Sahiljeet; Gutierrez, Olaya I. Brewer; Keane, M. G.; Ghamdi, Sarah S. Al; Ngamruengphong, Saowanee; Kumbhari, Vivek; Khashab, Mouen A.

doi:10.1016/j.gie.2020.09.041

Cited by 54 publications

(58 citation statements)

References 31 publications

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“…It is a graphical representation of the relationship between the learning effort and outcome. 10 There should be two milestones for budding gastroenterology fellows in any endoscopic intervention-proficiency and mastery. With new interventions, the learning curve should always be determined, so as to minimize complications and have widespread acceptance of the new technique.…”

Section: Commentarymentioning

confidence: 99%

“…Jovani et al published a retrospectively analyzed study of 87 consecutive GOO patients (malignant etiology-88%) who underwent EUS-GE in a tertiary care center in the USA from 2014-2020. 10 They excluded three patients for altered surgical anatomy and 11 patients for noncautery-enhanced procedures to maintain homogeneity. They used freehand cautery-enhanced intervention for the rest of the 73 patients.…”

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confidence: 99%

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EUS-guided Gastroenterostomy: Assessing the Competence of the Endoscopist

Jena

Rana

2020

Journal of Digestive Endoscopy

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Assessing competence is of utmost importance for complex EUS procedures like EUS-guided gastroenterostomy (EUS-GE) that are associated with higher risk of procedural complications. It is a matter of intense debate on what is the training needed to carry out these interventions, how to judge for competence, and who can perform these newer interventions. The procedure has several variations including the methods to identify the jejunal loops on EUS like direct puncture, balloon-assisted, and hybrid rendezvous with ultrathin endoscope. Therefore, there is lack of clarity on the role and ways of assessing the learning curve for EUS-GE. In this news and views, we are discussing two studies that assessed the learning curve for EUS-GE.

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Section: Commentarymentioning

confidence: 99%

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confidence: 99%

EUS-guided Gastroenterostomy: Assessing the Competence of the Endoscopist

Jena

Rana

2020

Journal of Digestive Endoscopy

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“…

We read with interest the article by Jovani et al 1 The authors concluded that based on the performance of a single operator, proficiency and mastery for EUS-guided gastroenterostomy (EUS-GE) are achieved after 25 and 40 procedures, respectively. Another recently published single-operator study from a different institution reported that 7 EUS-GE cases were adequate to achieve efficiency.

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confidence: 99%

Learning curves for EUS: single operators, endoscopy teams, and institutions

Elfanagely

Tse

Rich

et al. 2021

Gastrointestinal Endoscopy

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We read with interest the article by Jovani et al. 1 The authors concluded that based on the performance of a single operator, proficiency and mastery for EUS-guided gastroenterostomy (EUS-GE) are achieved after 25 and 40 procedures, respectively. Another recently published single-operator study from a different institution reported that 7 EUS-GE cases were adequate to achieve efficiency. 2 The adverse events from these 2 endoscopists showed discrepancy: 5.6% (4 of 73 cases) in Jovani et al 1 versus 26% (6 of 23 cases) in Tyberg et al. 2 Although single-operator studies can be informative on the learning curve at an individual level for a particular procedure, its results may not be generalizable. In addition, as gastroenterology becomes increasingly multidisciplinary, there should be caution in applying the concept of a learning curve on individual endoscopists because there are other team members involved in the procedure. The progressive increase in efficiency and decline in adverse events may be reflective of the increased experience among the proceduralists and their support team, including endoscopy nurses, anesthesiologists, and technicians. 3 For a broader perspective on the learning curve for EUS at an institution level, another retrospective review of 968 consecutive EUS procedures (864 patients; 54% female; 79% white; mean age, 61 years) performed during the first 5 years (2015)(2016)(2017)(2018)(2019) of a new EUS program with 6 endoscopists found that the adverse event rate was inversely correlated with years of experience (P Z .02), with the probability of an adverse event decreasing by an average of 22% per year (stratification of the incidence of adverse events by year showed a decline in the incidence of adverse events from 12.7% in 2015 to 4.0% in 2019). 4 Overall, mastery of an intervention depends not only on individual attributes but also on the practice environment and the multidisciplinary team members involved.

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“…Furthermore, 33 % of the procedures were completed in the first 2 years, between 2015 and 2016. A recent study evaluating the learning curve for EUS-GE in a single operator found that the majority of the AEs occurred within the operator’s first 39 cases 3 . When measuring mastery using cumulative sum analysis, Jovani et al found that 25 cases were needed to achieve proficiency in EUS-GE, while 40 cases were needed to achieve mastery 3 .…”

mentioning

confidence: 99%

“…A recent study evaluating the learning curve for EUS-GE in a single operator found that the majority of the AEs occurred within the operator’s first 39 cases 3 . When measuring mastery using cumulative sum analysis, Jovani et al found that 25 cases were needed to achieve proficiency in EUS-GE, while 40 cases were needed to achieve mastery 3 . Given these findings, we seek clarification on three particular issues: whether the authors noted higher rates of AEs in the earlier years (since the technique for EUS-GE has evolved over the last 5 years), whether the rate of AEs decreased as operators gained more experience, and whether there was any substantial difference in AEs among the technique of EUS-GE (balloon assisted versus direct technique).…”

mentioning

confidence: 99%